Step 3 - Identification & Assessment of Potential Health Impacts
The purpose of this step is identification, assessment and/or appraisal of potential health impacts. This is actually the "doing" step of a HIA. Step 3 of a HIA usually includes two phases: the identification of health impacts and assessment/appraisal of the evidence. Some guides to HIA separate this step into two steps - step 3 (identification) and step 4 (assessment/appraisal) of a HIA. The usual process or actions that are undertaken as part of the identification and assessment of health impacts step include:
- developing a profile of the communities/population groups etc affected by the proposal - this might include those directly affected and those indirectly affected by the proposal eg. those residents not living immediately next to the proposed smelter but who may be affected by smoke from a proposed smelter.
- collection of information to identify some of the key issues and potential health impacts by reviewing the literature.
- collection of information on potential health impacts through other agreed means eg. quantitative and qualitative collection of information. This could range from reviewing existing data (eg. census data) through to collection of new information through a survey - depending on the type of HIA.
- assessing or appraising the identified potential health impacts - this is often done using a matrix that sets out the nature and where possible size of the impact and how measurable the impact is (qualitative, estimable or calculable); and the risk of impact (is it definite, probable or speculative). (Ref: Merseyside Guidelines).
- quantification and valuation of health impacts - this might include "weighting" the evidence using an evidence hierarchy.
The main outcome of this step is the development of a document that "maps" the potential health outcomes of the proposal for use by the Steering Group/Committee in the negotiation and decision making step. See the section on tools for HIA for more information on this stage.
Identifying Potential Health Impacts
by Sarah Simpson
The purpose of this step is identification, assessment and/or appraisal of potential
health impacts. Step 3 of a HIA usually includes two phases:
- the identification (also known as profiling) of health impacts and
- assessment (also known as mapping/appraisal/risk assessment and quantification) of the identified health impacts.
This section takes a detailed look at the identification/profiling of potential
health impacts. More detailed information about assessing identified health impacts is covered
below.
As identified previously, the level of information you collect about
potential health impacts will be determined by the scope of your HIA: is
it rapid, intermediate or comprehensive? Two key issues from scoping are of immediate relevance to
step 3:
- the scope of your HIA will in part be determined by the level of resources (human and financial) and time available to undertake the HIA; and
- agreed definitions about "health", how and which "health impacts" will be measured, what counts as evidence and what, if any, principles will inform the HIA.
The usual process or actions that are undertaken as part of the identification of health impacts step include:
- Profiling of the policy or program context
- Collection of information - through a review of the literature and other methods eg. content analysis of the print media, interviews with key informants - to identify and verify potential health impacts
This first part of the stap is about collecting and collating information -
not assessment or appraisal.
"Profiling" includes identification of the program or policy context, target
populations and data collection on relevant population groups or
sub-population groups. Profiling
then provides a basis against which to identify and then appraise
potential health impacts. The profile might include those populations directly and indirectly affected
by the proposal. For example both those residents who live next to a proposed smelter and those who
live well away from the proposed smelter but who may be affected by smoke
and/or air borne pollutants from the smelter. Profiling is done through reviewing existing data - this might
include documents such as the NSW Chief Health Officer's report and/or
similar demographic profiles.
Information for identification of potential health impacts is usually collected by:
- reviewing the literature. How you review the literature, what literature you review (only peer reviewWednesday, November 15, 2006 10:08lusion/exclusion criteria will be determined by agreed parameters of your HIA eg. how health is defined; and
- collecting information from other sources such as "experts", all stakeholders - this might include those indirectly affected as well as those population groups directly affected by the proposal. This step can be done through individual interviews, focus groups or community consultations. Again the extent to which you can collect information from other sources will be determined by the agreed scope of your HIA eg. if your HIA is informed by the principle of community participation then it is important that there are opportunities for the community to participate in the HIA - a community consultation is one way of doing this.
Collecting
information from other sources is important not only for identification of
additional information about potential health impacts but also as a way of
"verifying" the findings from the review of the literature.
Another issue to consider when obtaining information from other sources is the
need for "risk communication". Sometimes
the findings from the literature review are made available to stakeholders
to facilitate discussion, enable identification of additional potential
health impacts and/or verification of the potential health impacts.
It may be that the findings of the literature review indicate that
the potential negative health impacts of the proposal will be minimal but
there is a community perception that these potential impacts pose
significant risk to their health. Consideration
should be given to how to manage these potential differences of opinion as
part of the consultation process. The
literature on "traditional" HIA includes guidance on risk
communication (see below).
Also while it is useful to provide key informants or stakeholders with an
overview of the main findings from the review of the literature, it may
also affect the identification of further potential health impacts ie.
they may limit their input to verifying the identified potential health
impacts and not identify other potential health impacts that have been
missed.
As with the other steps in HIA, there are many tools and ways that
identification of potential health impacts can be undertaken.
If you are undertaking a more "traditional" HIA ie. one that is
focused on assessing the potential health impacts of a development
proposal such as new landfill site, the enHealth
Health Impact Assessment Guidelines,
September 2001 provide a useful guide on profiling and risk assessment of
the health impacts (including using quantitative risk assessment).
In addition the New Zealand Ministry of
Health, A Guide to Health Impact Assessment
has some useful tips for undertaking the profiling step. Where your HIA is of
a policy or program and uses a broad definition of health, there are a
range of guides that will be of assistance to you in undertaking this step
- ranging from the Merseyside
Guidelines for Health Impact Assessment to An
Easy Guide to Health Impact Assessment for Local Authorities.
The key point about this step however is that it is important to identify the
skills that are required to undertake a literature review, to facilitate a
workshop, focus group or community consultation. In this instance a good handbook on undertaking research
(qualitative and/or quantitative) and/or on action research will be just
as useful as a guide to HIA. Health
impact assessment is after all a combination of procedures, methods and
tools for identifying and assessing potential health impacts.
Assessing Potential Health Impacts
by Sarah Simpson
This section takes a closer look at the process of
assessment of identified potential health impacts. Detailed information about the identification of health impacts was
covered in the previous section.
Assessment includes collating the information collected
from all sources (eg. literature, key informants) to list the potential
health impacts and provide an assessment of the:
- potential severity of the health impact eg. very negative (---), neutral or slightly positive (+)
- likelihood/certainty that the potential health impact will occur - eg. definite, probable or speculative
- whether the potential health impacts are differentially distributed eg. children will be affected more significantly than adults
- whether potential differential health impacts are inequitable
One way of bringing this information together to assist
in appraising the potential health impacts is to use a matrix (see Merseyside
Guidelines or Douglas et al, 2001). This is useful not only for the HIA Steering Group (in developing
their recommendations) but also for the decision makers - as a way of
presenting the information in an easy to follow format. The Bro Taf
Guidelines for Health Inequalities Impact Assessment Rapid Appraisal -
Determinants of Health Brainstorm (2003) also provide a useful and
alternative way of categorising/mapping the potential health risks.
Guidelines or standards can be used to assist in
assessing the level of impact or risk, such as guidelines for water or air
quality. However guidelines are not available for every possible potential risk or health impact and
have limitation including:
- they reflect the knowledge about the particular health impact at the time of publication
- do not necessarily address the social, community or psychological aspects of health and well-being effectively
- may not identify potential positive health impacts
- don't usually address differential impact that may arise due to age, gender etc eg. children absorb lead more easily than adults (enHealth, 2001, p.16)
The enHealth
Guidelines for HIA (2001) include a set of criteria for assessing
impact significance (see page 18 of the guidelines), including criteria
such as socioeconomic importance and local sensitivity - perception
about risk (see below). This
issue highlights why it is important to ensure that you collect
information about potential impacts from a range of different sources -
the literature (peer reviewed and grey) and key informants (technical and
community experts).
As with the identification of health impacts, how you
have scoped will impact on the information available at the assessment
step. For example if you have
used a "tight" definition of health (ie. limited to physiological
risk), you may not have identified as wide a range of potential health
impacts (positive and negative) as you could have:
The
risk assessment process should identify the impacts that a proposed
development is likely to have on health. These effects could be negative. or positive such as improved
recreational opportunities or job opportunities. This is an aspect overlooked by the typical assessment that does
not fully consider human health, and is one reason to include a broader
view of health in the impact assessment process.(enHealth, 2001,
p.15)
A proposed manufacturing plant for example has both
potentially positive and negative health impacts - new job opportunities
for people living in the area and potentially increased levels of noise
and/or air pollution. The
increased job opportunities would be particularly important in areas where
there are high levels of unemployment. Increased job opportunities may potentially result in improved
levels of health (physical and mental) in the community.
It's also important to identify the source of
information for each potential health impact - whether this was
something identified through the literature review, or key informants
and/or both sources. This is
important because it provides an indication about whether the "expert"
view is in conflict with the "lay" view about perceived potential
health impacts. Where HIA is
used for decision making such information is essential. For example there may be no "expert" level evidence that the
increased noise and/or air pollution levels as a result of a proposed
manufacturing plant will impact adversely on human health.Local residents however may perceive the increased noise and/or air
pollution levels as posing a risk and this needs to be taken into account
as part of the decision making process. Perceived risk may result in a negative health impact in terms of
mental and social health - ie. people are unhappy living there because
there is a perception that the manufacturing plant is a negative outcome.
As part of this process it's useful to be able to
explain how the potential health impact arises - the potential causal
pathway. For example, one of
the potential health impacts of a proposed freeway extension that enables
drivers to bypass a regional centre and small towns is a decrease in
physical injury rates due to decreased traffic through the town centre,
including a decreased number of trucks.
Another potential health impact may be a decrease in the number of
asthma and/or other respiratory events among young children who live close
to the existing road, due to decreased traffic which in turn decreases the
amount of air and noise pollution. However
another impact of the proposal is that due to less through traffic, fewer
people stop and spend money in the town centre, meaning that businesses
(eg. cafes and convenience stores) may close due to a decrease in income.A potential negative health impact could be that the people owning
the businesses have increasing levels of physical and/or mental illness
due to stress due to lack of income, a failing business, change health
related behaviours (ie. increased smoking or drinking) and/or having to
move away from their home and family networks.
Acknowledgments
I would particularly like to acknowledge the assistance of Mary Mahoney, HIA Unit, Deakin University and Caron Bowen, former Program Manager HIA, London Health Observatory in providing insights into this step of a HIA.
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